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periodontal concerns and pregnancy

I had a 30 year old patient who hadn’t had her teeth cleaned in a year and a half. Prior to that cleaning it had been about 5-6 years. She was in my office a few weeks back for pain in her upper left quad. My Dr probed the area and 4mm pockets were present on DB of #14 & MB of #15. Today when probing that area in those exact same locations there were 6mm pockets. Between #’s 30-31 there were 5mm pockets present. She is also 31 weeks pregnant. I did not perform a cleaning and referred her to a periodontist for an evaluation due to risk of bacteria entering blood stream during pregnancy. What would everyone else do?



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2 Answers

First, I would have gotten a release from her OB/GYN specifically asking if the patient and baby is healthy enough for SRP’s (or even localized SRPs) and which anesthetic is recommended (normally 2% Lido w/epi or 3% mepivicaine is okay). Then I would have proceeded! Here’s why: more and more studies are showing a positive correlation between untreated moderate-severe periodontal disease and preterm and low birth weight babies. More studies need to be done to establish association however.
 
If she follows through with the periodontist referral all is great. But if she doesn’t, I’d hate to see her be swallowing bacterial endotoxins every day, them entering her blood stream, then crossing the placenta barrier to baby. Arguably, this constant exposure to endotoxins would be worse than the exposure during scaling. I think the benefits would outweigh the risks.
 
Also worth mentioning, she could also have pregnancy gingivitis and have inflammation due to hormones. Was there bone loss? Recession? Subgingival calculus? It’s definitely worth assessing more than just probe depths to get a comprehensive picture of the patient’s condition.
 
That’s just what I would do. I’m not right and you’re not wrong, or vice versa, just a different way of looking at it!

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Always get clearance from OBGYN for anything you may use. Usually you need to wait until they are out of the first trimester for most treatment. Oraqix is a great option in second trimester. Always get clearance and never do anything that can wait until after pregnancy unless it’s an emergency. The health of her mouth and gums need to be addressed before she has her baby.

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